India, top steriliser of women, needs new contraceptive ideas

NEW DELHI, July 17 (Thomson Reuters Foundation) -
E ighty-five percent of India's family planning budget is used to
promote and conduct sterilisations on women, the head of a
prominent charity said on Friday, calling for more funds to be
channelled towards providing alternative forms of contraception.

Poonam Muttreja, executive director of the Population
Foundation of India (PFI), said an analysis of the national
family planning programme's budget for 2013/14 found that 3.4
billion rupees ($53 million) out of a total 4 billion rupees
($63 million) was spent on female sterilisation.

"There is a total emphasis on sterilisation in India.
Eighty-five percent of the expenditure for family planning is on
incentives for sterilisation, 13.5 percent is on equipment and
salaries, and just 1.5 percent is on other forms of
contraception," said Muttreja.

India's efforts to rein in population growth have been
described as the most draconian after China. Birth rates have
fallen in recent decades, but population growth is still among
the world's fastest.

The world's top steriliser of women, India came under global
scrutiny for its sterilisation drive last November when 15 women
died and scores of others were hospitalised after surgery at a
sterilisation camp in the eastern state of Chhattisgarh.

Investigations found the deaths in Bilaspur district were
due to unhygienic conditions, dirty medical instruments and
equipment and an overall lack of care for the patients who were
poor tribal and low-caste women.

Authorities have since put in place guidelines and are
training local health workers on conducting safe and sanitary
surgeries, based on findings of a PFI study into the deaths, but
incentivised, target-driven sterilisation continues.

Doctors, nurses and health workers receive cash incentives
for promoting and carrying out sterilisations. Patients are also
given compensation - ranging from 600 rupees ($10) to 1,100
rupees ($17) for tubectomies and vasectomies respectively.

"The doctor is getting 250 rupees per surgery. Why would he
bother to do only 10 or 20 surgeries when he can do 80? In the
Bilaspur case, this is what happened," Muttreja said.

"The doctor did not even change his laparoscope once during
the 86 operations. He didn't change his gloves once. He didn't
have the time."

The doctor denies charges of culpable homicide not amounting
to murder and told the Thomson Reuters Foundation that the
deaths were caused due to spurious medication supplied by the
authorities. The trial is yet to come before the court.

CUTTING MATERNAL MORTALITY

With more than four million Indians sterilised every year,
the incentive system encourages officials and doctors to cut
corners and uneducated women are often given money for surgery
without knowing the risks, say activists.

Muttreja said India had to improve access to other forms of
contraception, widen the basket of contraceptives on offer and
invest in providing better reproductive health services.

The government currently offers only five choices to men and
women - female sterilisation, male sterilisation, Intrauterine
Contraceptive Devices (IUCD), oral contraceptives, and condoms.

In contrast, other countries in the region such as Nepal,
Bhutan, Bangladesh and Indonesia have seven contraceptive
methods available which include injectables and implants.

An estimated 32 million Indian women do not have access to
any form of modern contraception and providing more choice,
together with screening and follow-up, will reduce numbers of
unintended pregnancies and help accelerate a fall in maternal
mortality rates.

In 2012, 178 women died per 100,000 live births in India,
down from 212 in 2007, according to the U.N. children's agency.
Despite the falling rates, the U.N. says India has made slow
progress on development targets on maternal deaths, assisted
births and ante-natal care.

"Women do need sterilisation as a option of family planning,
but we need it conducted properly and under hygienic conditions.
The manner in which sterilisation is being done in India
currently is unethical," Muttreja said.

"We will see a huge reduction in maternal mortality if we
invest in other methods of family planning also."
(Reporting by Nita Bhalla. Additonal reporting by Jatindra Dash
in Bhubaneswar. Editing by Ros Russell; Please credit the
Thomson Reuters Foundation, the charitable arm of Thomson
Reuters, that covers humanitarian news, women's rights,
trafficking, corruption and climate change. Visit www.trust.org)